List Bill Procedures

Easy To use Forms

Acceptance of List Bill Program DOC-9773 Page 1 of 2

Acceptance of List Bill Program DOC-9773 Page 2 of 2

Acceptance of List Bill Program DOC-9773

Acceptance of List Bill Program DOC-9773

Employers Bankdraft Acceptance Program If a company bankdraft is selected the employer agrees to be responsible for removing employees from the bankdraft account once the employee is no longer eligible to participate in the Companies bankdraft program and that PALIC will not be responsible for refunding any employees premium if the employer failed to notify PALIC prior to processing the deduction from the employers account. We also agree to honor all changes resulting from premium increases due to age changes, rate increase and dependent eligibility when presented. DOC-7810

Employers Bankdraft Authorization DOC-7812

Employers Bankdraft Authorization DOC-7812

List Bill New Business Transmittal Form Standard Issue 150.00 $30 Per HSP / HCS Apps with a $150 max per employer. DOC-7813

List Bill New Business Transmittal Form Contingent Issue New employee are eligible for benefits in:  30 days  60 days  90 days days DOC-8213

List Bill New Business Transmittal Form Contingent Issue Employment Date For New Employee Additions DOC-8213

List Bill New Business Transmittal Form Contingent Issue We attest that during the past three (3) months, except for minor illness of one (1) week or less or pregnancy, that the employees listed above have not had any illness, injury or health related problem that has prohibited any proposed insured from working full time at his/her regular occupation or performing the normal activities of a person of the same age. DOC-8213

Pay Periods Semi-Monthly 1st & 15th – Billing Frequency (Monthly) 24 pay periods a year Pay Periods Semi-Monthly 1st & 15th – Billing Frequency (Monthly) X Pay Periods……………………………………….…… Monthly Billing ……………………………..………. Effective Date of Coverage…………………….. Example E B Copy of List Bill Transmittal to the employer so they can start setting up deductions Send Transmittal and Apps to HO Sunday Monday Tuesday Wednesday Thursday Friday Saturday 1 X Applications 2 3 4 5 LBT 6 Enrollment 7 8 9 10 11 12 13 1st Deduction 14 15 X 16 17 18 19 20 List Bill sent 15 days prior to due date 21 22 23 24 25 B 26 27 28 29 30 31 Sunday Monday Tuesday Wednesday Thursday Friday Saturday 2nd Deduction X 1 2 3 Effective Date and billing Due Date. Additions must always be set for the same day of the month as the original Effective day 4 5 6 7 8 9 E 10 1st Deduction for second months premium etc. 11 12 13 14 X 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Pay Periods Other than the Semi-Monthly (24 Pay Periods) Weekly Pay Periods (52 Pay Periods) : There are several times a year that an employee takes home five paychecks in a month instead of four. The 52 weeks in a year don't get parceled out evenly between the different months. Many companies that are set up on a weekly pay system with MONTHLY insurance premiums will use what is known as a “Premium Holiday” where no deduction is taken out of the employee’s paycheck for insurance premium. Below is a listing of the months with 5 weeks. 2017: Mar, Jun, Sept, Dec. 2022: Apr, Jul, Sept, Dec. 2018: Mar, Jun, Aug, Nov. 2023: Mar, Jun, Sept, Dec. 2019: Mar, May, Aug, Nov. 2024: Mar, May, Aug, Nov. 2020: Jan, May, Jul, Oct. 2025: Jan, May, Aug, Nov. 2021: Jan, Apr, Jul, Oct, Dec.

Pay Periods Other than the Semi-Monthly (24 Pay Periods) Bi-Weekly Pay Periods (26 Pay Periods) : If the employee gets paid every two weeks, there will also be months where they will get three paychecks instead of two. This will only occur if your payday falls on the first Friday of a month with five Fridays. However, if your payday falls on the second Friday of those months, you will only get the usual two paychecks. Check the five-Friday months to see when your payday will fall. Many companies that are set up on a weekly pay system with MONTHLY insurance premiums will use what is known as a “Premium Holiday” where no deduction is taken out of the employee’s paycheck for insurance premium. Below is a listing of the months with 5 weeks.

Payroll Deduction and Billing Cycles

Employer Welcome Letter

Rules for Contingent Issue Underwriting

Rules for Contingent Issue Underwriting Employer Eligibility: The industry must not be on this list of Ineligible Industries. Adult Entertainers/Dancers, Armed Services (Active Duty), Asbestos/Toxic Chemical Workers, Athletes-Professional or Semi-Professional (who participate in a contact sport such as (Football, Soccer, Basketball, Baseball, Wrestling), Crop Dusters, Explosive Workers, Gambling and Racing related workers, High Rise Steel workers, Legal Professionals-We will consider attorney’s handling criminal cases not civil cases, Physicians, Race Car Drivers, Rodeo and Circus worker, skydivers, Stuntmen, Underground Workers, Unemployed due to disability, Window washers above 3 stories

Rules for Contingent Issue Underwriting Employee Eligibility: The health and Critical Illness plans are available as long as the employee has not reached age 65. Employee’s must work at least 28 hours weekly to be included in the list bill. INITIAL ENROLLMENT PERIOD is the time that an employee is eligible and applying for coverage and last for 31 days. For employee’s to be added after the initial enrollment period, they will be considered a late enrollee and must wait until the waiting period is met. This period is determined by the employer and the employee must apply within 31 days after that time period. Otherwise they will be subject to full underwriting.

Rules for Contingent Issue Underwriting Dependent Eligibility: Spouses-Ages 17-65, Dependent Children Ages 0-25 (This may vary by state) Coverage may be applied for when the employee is eligible and applying for coverage in order to qualify for contingent issue. All applicants purchasing Critical Illness will have to answer the questions on the Critical Illness application. If an employee marries, adopts a child or is court ordered to cover eligible dependents, those dependents must apply for coverage within 31 days of the time they are eligible. Anyone applying meeting this and wants to purchase Critical Illness must answer all of the questions on the Critical Illness application. - Any late enrollee must show evidence of insurability at the expense of the employee  

Eligibility Guidelines

Eligibility Guidelines

Post Sales and Service Check all applications. Do you have all the required information and signatures? Complete the New Business Transmittal. Provide a copy of the New Business Transmittal to payroll administrator. Review the payroll administrator and confirm when the first deductions will start and when the first billing will arrive.

Post Sales and Service Check all applications. Do you have all the required information and signatures? Complete the New Business Transmittal. Provide a copy of the New Business Transmittal to payroll administrator. Review the payroll administrator and confirm when the first deductions will start and when the first billing will arrive.

Rules for Contingent Issue Underwriting 1. The first requirement for an agent to use the eApp for an employer sponsored list bill is that prior to starting the enrollment they must send in the Employers Acceptance of List Bill Form 9773. In presenting an Employer Bankdraft Program both the Employer Bankdraft Acceptance Form 7810 and the Employer Bank Draft Authorization Form 7812. must be sent in prior to starting the enrollment. Once we receive the completed forms (that adheres to list bill rules) the HO will email or fax the agent a List Bill Number.

E-App & List Bill Enrollments 2. We have added Payment Mode with a drop down box to the first screen. The default will show as Monthly Bankdraft. Once you select either Monthly List Bill or Monthly Employer Bankdraft a box will pop up asking for the Billing Number and the Affiliation Code (which is typically NA). Both will need to be entered into the eApp before you can proceed with the application process. The billing number will start with three alpha letters GBN and followed by 6 numeric digits. Example GBN 012345. – Zero not an alpha “O”

Multiple agents using the same computer When multiple agents use the same computer, all agents must add their Agent IDs. You can do this by selecting from the opening screen on the eApp. Also make sure the Agent ID is correct before you start the application process. The system retains the last number used until changed.

Important To Remember Mailing Address A. On payroll deduction business you must set the effective date 6 weeks after you complete the enrollment to allow the payroll clerk enough time to enter the deduction into their payroll system as well as time to deduct the premium amount from at least 2 pay periods.   B. Age is based on the effective date of coverage so make sure you have the correct age quoted otherwise the premium will be incorrect and will cause an amendment and a delay in the group. C. We only do MONTHLY Bills (24 pay periods—2 pay periods a month) we DO NOT do 13thly (26 pay periods—paid every 2 weeks). We send a bill to the employer 15 days prior to the effective date. D. All additions to a group must be on the same day of the month as the current employers list bill. We do not allow for multiple billing dates in the same month. E. All groups must be pre-approved to receive a Group Bill Number. Email all setup forms to the HO. Please use palic@neweralife.com or if you prefer to fax in your forms please fax forms to 281-310-8292. To receive approval and Group Bill Number Mailing Address Philadelphia American Life P.O. Box 4884 Houston, TX 77210-4884 Attn: New Business

Important To Remember Mailing Address D. All additions to a group must be on the same day of the month as the current employers list bill. We do not allow for multiple billing dates in the same month.   E. All groups must be pre-approved to receive a Group Bill Number. Email all setup forms to the HO. Please use listbill@neweralife.com or if you prefer to fax in your forms please fax forms to 281-310-8292. To receive approval and Group Bill Number and Affiliation Code. Mailing Address Philadelphia American Life P.O. Box 4884 Houston, TX 77210-4884 Attn: New Business

Thank You

Additional Slides

Workflow Employer Sponsored Plans Secures Acceptance of List Bill Form and Submits to New Business Agent Enrolls Group and Completes Transmittal Form with Employer and Submits Form to Underwriter with Policy Fee ($30 per employee with a max of $150) Underwriting reviews Applications and makes decision based on pre-determined requirements Underwriter Submits Transmittal to Billing Team for Billing Coordination with Employer List Bill – 9773 Employer Draft -7810 List Bill – 7813 List Bill Contingent - 8213 Employer Draft - 7812 New Business Issues Policies and Mails policies to designated person for delivery Billing Team Mails Initial Bill and Letter to Employer or Coordinates Initial Draft Notice Employer remits Insurance Premium to PALIC

Pay Periods Semi-Monthly 1st & 15th – Billing Frequency (Monthly) X 24 pay periods a year Example Effective Date of Coverage…………………….. E Monthly Billing ……………………………..………. B Copy of List Bill Transmittal Provide listing of employees and deductions to employer. Send applications and List Bill Transmittal to PALIC Sunday Monday Tuesday Wednesday Thursday Friday Saturday 1 X Applications 2 3 4 5 LBT 6 7 8 9 10 11 12 13 1st Deduction 14 15 X 16 17 18 19 20 21 22 23 24 25 B 26 27 List Bill sent 15 days prior to due date 28 29 30 31 Sunday Monday Tuesday Wednesday Thursday Friday Saturday 2nd Deduction X 1 2 3 Effective Date and billing Due Date. Additions will be on the same day of the following month(s) 4 5 6 7 8 E 9 10 1st Deduction for second months premium etc. 11 12 13 14 X 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30